大腸クローン病と潰瘍性大腸炎の混合型と考えられる1症例

A Case of Mixed Form of Granulomatous Ileocolitis and Ulcerative Colitis

　1960年Lockhart-Mummery and Morson¹⁾は非特異性肉芽腫性病変をしめす大腸炎を潰瘍性大腸炎より分離し，“Crohn's disease of the large intestine”と呼んだ．またWolf and Marshak²⁾は“Granulomatous colitis”という名称を用いた．それ以来欧米では多くの症例が報告されたが，1966年Marshak³⁾らは非特異性肉芽腫性病変が回腸に及んでいる場合，Regional enteritisやGranulomatous colitisとは診断，治療，予後の点で異なるとし，これを“Granulomatous ileocolitis”と名づけ，ひとつのclinical entityとした．われわれは最近病変が回腸末端より直腸に及び，組織学的にはGranulomatous ileocolitisとUlcerative Colitisとの混合型と考えられる症例を経験したので報告し，若干の考察を加える．

　A twenty five years old man was admitted to Sumitomo Besshi Hospital in June 1969, with one year history of watery diarrhea, abdominal pain, weight loss and weakness. Surgical treatment was recommended after barium enema examination which was suggestive of granulomatous ileocolitis. A right hemicolectomy and ileotransversostomy were performed in October 1970. He was readmitted in February 1972, because of recurrence of the disease in the remaining colon. His course was complicated by uveitis of the left eye which disappeared after left hemicolectomy and ileoproctostomy performed in June 1973.

　The disease is still present in the rectum, associated with perianal fistula.

　X-ray examination: Barium enema at first admission showed diffuse involvement of the terminal ileum and right half of the colon, associated with skip lesion in the mid descending colon. Barium enema at second admission revealed that whole of the remaining colon was involved. On both examinations rigidity of the wall and pseudopolypoid mucosal change were marked. No abnormalities were found in the rectum.

　Pathological findings: Grossly serosa and mesenterium were edematous and multiple longitudinal ulcers were seen in the mucosa. Microscopically, the inflammatory component involved all layers of the bowel wall. Aggregation of small round cells, lymphoid follicles and noncaseating sarcoid-like granulomas were present in variable density not only in the submucosa but also in the lamina propria, subserosa, and to much lesser extent in the muscularis propria.

　In 1972 Lockhart-Mummery described the definition of Crohn's disease of large intestine through his experience for twenty years, and many papers about the disease have been reported after that. But the relationship between this disease and ulcerative colitis remains unknown. Meanwhile since our case has both the features of Crohn's disease of the large intestine and ulcerative colitis, we had to classify it as a mixed type between the two. We must be careful at present in the diagnosis of ulcerative diseases of the colon such as ours. We expect to make more definite diagnosis in near future.